A purpose
(A) guidance of medical institutions, disease prevention and control institutions in the gastro-intestinal virus epidemic reporting and monitoring;
(B) guidance for disease prevention and control institutions epidemiological investigations and laboratory testing;
(C) guiding disease prevention and control institutions, medical institutions in epidemic prevention and public emergency.
Second, the etiology
Hand, Foot and mouth disease caused mainly by small RNA virus, an intestinal virus the Coxsackie virus (Coxasckie virus) A group of 16,4,5,7,9,10, B group 2,5,13; Egypt The virus can (ECHO viruses) and enterovirus 71 (EV71), which Cox Al6 to EV71 and the most common type.
Intestinal virus suitable for wet, hot environment survival and spread of the ether, bile salt to chlorine and other non-sensitive, 75 percent alcohol and 5 percent to the Soviet Union nor can their inactivated, but sensitive to ultraviolet light and dry. Various oxidants (potassium permanganate, bleaching powder, etc.), formaldehyde, iodine can be inactivated virus. Virus in 50 �� can be rapidly inactivated, but the price of 1 mol cation environment can increase the virus’s resistance to heat inactivation, the virus can survive 4 �� in one year, at -20 �� can be stored for a long time, the virus can be outside environment Long-term survival.
Third, epidemiology
(A) Prevalence
Hand, Foot and mouth disease is a global infectious diseases, most of the world epidemic of the disease are reported. 1957 New Zealand reported for the first time the disease. 1958 isolated from the Coxsackie virus, in 1959 named by hand, foot and mouth disease. Early detection of hand, foot and mouth disease pathogens mainly Cox A16 type, 1969 EV71 was first recognized in the United States. Since then EV71 infection and infection alternating Cox A16, hand, foot and mouth disease into the main pathogens.
The mid-1970s, Bulgaria, Hungary successive outbreaks to the central nervous system as the main clinical features of EV71 epidemic, 1975 Bulgaria reported cases 750 cases, of which 149 were caused by paralysis, 44 people were killed. 1994 Britain in a Cox A16 caused by the hand, foot and mouth disease outbreaks, mostly in infants and young children 1-4 years old, most patients in less serious symptoms. Britain since 1963, the epidemiological data show that hand, foot and mouth disease epidemic interval for 2-3 years. In the late 1990s, EV71 epidemic began in East Asia. 1997 Malaysia has mainly caused by the EV71 of hand, foot and mouth disease epidemic, 4-August total of 2,628 people incidence 4-June there were 29 patients died.
China’s Shanghai in 1981 first reported the disease, since then, Beijing, Hebei, Tianjin, Fujian, Jilin, Shandong, Hubei, Guangdong and Qinghai provinces, and other 10 have reported the disease. 1983 in Tianjin, Cox A16 arising from the Hand, Foot and mouth disease outbreaks, 5-October, has more than 7,000 cases. After two years after sporadic low-level, the 1986 outbreak again. 1995 from the Wuhan Institute of hand, foot and mouth virus isolated from patients EV71, 1998 in Shenzhen City, health and epidemic prevention station from hand, foot and mouth disease in samples isolated from the EV71.
In 1998, China’s Taiwan region EV71 infection caused by hand, foot and mouth disease and herpangina pandemic, monitoring post at a total of 129,106 cases of reported cases. That there were 405 cases of severe patients, 78 patients died, mostly children under 5 years of age. Severe cases of complications including encephalitis, aseptic meningitis, pulmonary edema, or pulmonary hemorrhage, and acute myocarditis Ruantan.
Hand, Foot and mouth disease epidemic no obvious regional. May be the year the incidence, summer and autumn Most of the incidence of a rare winter. During the epidemic, in kindergartens and nurseries collective infection and pathogenesis of the family gathered. Strong infectious intestinal virus, the proportion of hidden infection, transmission complex, spread faster, in a short period of time can cause large-scale pandemic, epidemic control and difficult.
(B) The source of infection and transmission
Is the only host intestinal virus, and patients with hidden infection caught the disease-based source of infection. Gastro-intestinal virus mainly by the fecal - I and / or respiratory droplets spread by contact with a patient can skin and mucous membrane of Paozhen infection. It can be spread by water or food is not clear. A few days prior to the onset of infected feces and throat virus can be detected, usually infectious disease within a week after the strongest.
Faeces of patients, of herpes and respiratory secretions and contaminated hands, towel, handkerchief, dental Cup, toys, utensils, milk equipment, bedding, underwear and medical apparatus, and so can cause the disease spread.
Susceptibility
People generally susceptible to intestinal virus, the dominant and recessive infection after infection are given specific immunity, the duration is not clear. Various types of the virus without cross-immunity. Each age group are infected with disease, but ≤ 3-year-old age group the highest incidence rate.
4, case definition
(1) clinical diagnosis of cases
Acute onset, fever, the Department of hands or feet in Ban Qiuzhen and herpes, hip or knee can also be a rash. Rash around the Yan Xing Hongyun, blister fluid less casual in the oral mucosa in the herpes, pain obvious. Some children may be accompanied by cough, runny nose, loss of appetite, nausea, vomiting and headache and other symptoms.
Severe cases: 1. A hand, foot and mouth disease in patients with clinical manifestations, accompanied by myoclonic, encephalitis or acute flaccid paralysis, heart failure, pulmonary edema, and so on. 2. Hand, Foot and mouth disease epidemic in infants and young children is no typical example of Hand, Foot and mouth disease, but with myoclonic fever, encephalitis or acute flaccid paralysis, heart failure, pulmonary edema, etc.
(B) laboratory diagnosis Case
Clinical diagnosis of patients with one of the following conditions, namely, laboratory diagnosis Case
1. Virus isolation
Since the throat swab or throat lotion, feces or anal swabs, cerebrospinal fluid or herpes fluid, and brain, lung, spleen, lymph nodes and other tissues isolated from the intestinal virus.
2. Serological test
In patients with specific IgM antibody positive, or acute and convalescent serum IgG antibodies are more than four times the increase.
3. DNA testing
Since the serum of patients, cerebrospinal fluid, throat swab or throat lotion, feces or anal swabs, cerebrospinal fluid or liquid herpes and brain, lung, spleen, lymph nodes and other tissues and other samples to detect pathogenic nucleic acid
5, the epidemic reporting
(A) Since May 2nd, 2008, hand, foot and mouth disease into Group C disease management. Various medical institutions at all levels should, in accordance with the “People’s Republic of China Diseases Prevention Law” and “infectious disease information reporting regulations,” the relevant provisions of the above cases with the definition of hand, foot and mouth disease cases reported.
(B) the contents of the report and methods
Found that patients with hand, foot and mouth, to the “People’s Republic of China statutory infectious disease report cards” in “other statutory management and focus on monitoring infectious diseases,” a column reporting the disease. Direct Network implementation of the medical institutions should be reported within 24 hours straight on the network. Not implemented network straight to the medical institutions should be sent within 24 hours of a report card of infectious diseases. Case report, “clinical case” and “laboratory diagnosis of cases of” categories. As for the laboratory diagnosis of cases, the report card should be in the “Remarks” column intestinal virus indicate the specific type, such as severe cases should be in the “Remarks” annotated “severe.”
(C) in some areas or collective units or epidemic outbreaks occurred, in accordance with a “sudden public health incidents Emergency Regulations”, “National contingency plans for sudden public health incidents,” a “sudden public health incidents and epidemic disease monitoring information management report “And relevant regulations, timely information to public health emergencies of the report.
(4) report information analysis and feedback
Disease prevention and control institutions at all levels to report information on the epidemic level by level examination. 22,400 county-level disease prevention and control agencies should visit the daily monitoring and analysis of data and found that abnormal increase or a clustering of cases of deaths or there should be timely and verified at the same level health administrative departments and higher-level disease prevention and control agencies reported. Disease prevention and control institutions at all levels should be timely to lower levels of disease control agencies and medical institutions outbreak of feedback information.
6, epidemiological investigation
Hand, Foot and Mouth Disease report found that the number of cases increased significantly, the distribution of the cases were gathered, a larger proportion of severe cases or in cases of death, should be organized epidemiological investigation. The main purpose of investigation: first, collecting relevant specimens for laboratory testing, clear pathogenic type identification and the second is to collect clinical data to understand the different types of intestinal virus pathogenicity, virulence, clinical disease caused by Types and treatment; three to clarify this pop / outbreak of the mode of transmission of infection and the risk factors in order to develop targeted prevention and control measures is the evaluation of four different control strategies and measures of effectiveness. Epidemiological surveys and questionnaires programme should be based on different objectives of the survey conducted specially designed.
7, laboratory tests
(A) hand-foot-mouth disease in the season, the provincial CDC to organize the cases of Hand, Foot and mouth disease laboratory surveillance. Prevalence of the disease in the province for at least a week collecting samples of 5-10 patients for testing. Specimen collection and preservation of samples submitted technical requirements and single-see Annex 1 and Annex 2. Detection of specimens see Annex 3. For severe cases, should be conducted on all cases of severe specimen collection and laboratory testing. For the outbreak of the cases should be collected specimens pathogen detection. Without the ability to test samples sent to the region could be conditional CDC lab for testing. Attention should be paid to collect specimens of the cases related information, fill out the questionnaire cases see Annex 4.
(B) the report of test results and feedback
The provinces every Friday will be the province has completed laboratory testing of cases and cases of survey results list (Annex 5) to upload the electronic version of the Chinese CDC for Disease Control and the Office of Emergency Treatment and by the polio virus disease lab. Chinese CDC reported throughout the meta-analysis of the results, feedback to the provincial CDC.
8, prevention and control measures
Hand, Foot and mouth disease transmission, infants and children generally susceptible. Children do individuals, families and nurseries in the health prevention is the key with this disease.
(A) personal preventive measures
1. It before meals, go out after hand washing with soap or liquid, such as children wash their hands and not to allow children to drink raw water, eat cold food, avoid contact with sick children;
2. Caregivers contact with children, young children for the replacement of diapers, after handling faecal have to wash their hands, and properly handle the dirt;
3. Infant use of baby bottles, pacifiers should make full use of before and after cleaning;
4. Prevalence of the disease during the period it is not appropriate to bring the crowd of children, the poor circulation of air in public places, pay attention to maintaining household sanitation, ventilation should always room, ground drying clothing;
5. Child-related symptoms appear to timely medical institutions to visit. Home treatment of children, not to contact with other children, parents must be promptly carried out on children’s clothing drying or disinfected, the faeces of patients with timely disinfection; mild in children with no hospital, to home treatment, rest, to reduce cross-infection.
(B) nurseries in primary and collective units, such as the prevention and control measures
1. This disease epidemic season, classrooms and dormitories, and other places to maintain good ventilation;
2. Daily on toys, appliances, personal hygiene, food items such as cleaning and disinfection;
3. For cleaning or disinfection work (especially cleaning toilets), the staff should wear gloves. After the cleaning work should immediately wash their hands;
4. Daily on the door handles, stair railings, desktop, and other objects to clean the surface disinfection;
5. Guiding children’s education to develop the habit of washing hands correctly;
6. Daily Chen Jian, found that children with suspicious, it is necessary to take timely delivery of the children attending, home to rest; children with the use of the items to immediately disinfected;
7. More children, we must promptly to the health and education sectors report. When the epidemic under control need to education and health departments may decide to nurseries in primary or vacation measures.
(C) medical institutions of prevention and control measures
1. Epidemic, the hospitals should be implemented at pre-screening consultation, and the production’s office (Taiwan) Jiezhen patients suspected of hand, foot and mouth, fever rash guide to children with special Clinic (Taiwan) treatment, waiting and treatment areas should be increased clean Disinfection frequency, indoor cleaning methods should be used wet cleaning;
2. Medical staff at clinics, nursing every patient, should be careful to wash his hands or sterilization;
3. Clinics, nursing care to patients in the course of a one-time non-use of equipment, materials to wipe disinfection;
4. The same wards should not be treated other non-intestinal infection in children. Children with severe isolation should be a separate treatment;
5. Hospitalized children used on the beds and tables and chairs and other facilities and items must be disinfected before use;
6. Children with respiratory secretions and feces and contaminated goods to be disinfected;
7. Medical institutions found that patients with hand, foot and mouth more or gastro-intestinal infection-related deaths, it is necessary to immediately to the local health administrative departments and disease control agencies reported.